What can we learn from pulmonary function testing in heart failure?

Abstract

Pulmonary diseases frequently coexist in heart failure (HF), thus posing diagnostic and therapeutic challenges to cardiologists evaluating patients with overlapping symptoms and implementing recommended HF treatments. There is a growing body of evidence suggesting that pulmonary function testing might provide useful information for the best management of these patients. The availability of portable devices, allowing the measurement of spirometry and lung diffusion capacity for carbon monoxide outside of hospital-based pulmonary lung function laboratories, provides an opportunity for a more widespread use of these measures in the cardiology community, but their interpretation can be challenging. In this work, after a brief review of the methodologies, we discuss the interpretation of pulmonary function testing in patients with HF alone or associated with pulmonary diseases, and its contribution in differentiating cardiac and pulmonary symptoms and preventing acute cardiac decompensation. In addition, we examined recent evidence suggesting how the use of pulmonary function testing may provide independent prognostic information in HF patients with and without pulmonary disorders, and help therapeutic decisions to fill the treatment gap that still exists in HF patients with concomitant pulmonary diseases.

Lung diffusion capacity in advanced heart failure: relation to central haemodynamics and outcome

“…Pulmonary diffusion capacity for carbon monoxide (D LCO ) is reduced in HF, 1,2,7,10,16,17 which was also confirmed in the current study when compared with the applied reference material.…”

“…11 However, the importance of D LCO may extend beyond that as studies of both HF patients with reduced ejection fraction 12 and preserved ejection fraction 24 have reported a significantly worse outcome and higher mortality rate in HF patients with lower diffusion capacity. 16,25 There were no significant changes in our results when patients diagnosed with COPD were excluded from all of our analysis; hence, we decided not to exclude them from the study. FEV 1 and FVC demonstrated the strongest relationship with event-free survival, but D LCO and V A were also found to be important prognostic markers.…”

It's time to move on from counting co‐morbidities to curing them: the case of chronic heart failure–chronic obstructive pulmonary disease co‐morbidity

“…A technical innovation consists in high‐performance mini‐portable imaging devices usable by any trained person, including patients, that allow high quality recording of heart and lung (and of any other body area) images by sonographic technique (the minidigital stethoscope) that can be analysed in real time and/or sent remotely as part of a monitoring programme or epidemiological investigation . This service can be coupled with other now available portable devices that record spirometry variables and lung diffusion capacity for carbon monoxide outside hospital‐based pulmonary lung function laboratories . Airflow obstruction and hyperinflation are the most important lung function abnormalities associated with COPD.…”

“…Airflow obstruction and hyperinflation are the most important lung function abnormalities associated with COPD. Among the spirometry metrics, FEV 1 /FVC under the lower limit of normality and the ratio of FEV 1 to slow vital capacity are generally used to indicate airway obstruction . D LCO is a measure of carbon dioxide gas diffusion from the alveolar space to the blood.…”

“…A few weeks ago an excellent review by Helgo Magnussen et al ., ‘ What can we learn from pulmonary function testing in heart failure? ’, was published in the Journal.…”